Prostate cancer is the most common non-dermatologic malignancy and is the second leading cause of death due to cancer in men in the United States. Early stage prostate cancer is potentially cured by radiation therapy or surgery, also known as radical prostatectomy. Radical prostatectomy can be performed in a traditional, open fashion or laparoscopically. Recently, robot-assisted laparoscopic radical prostatectomy (RALP) using daVinci(R) surgical robot system has gained wide acceptance. The preservation of the neurovascular bundle (NVB) including cavernous nerves during radical prostatectomy improves the postoperative recovery of sexual potency. However, NVB can be difficult to visualize due to the periprostatic connective tissue and intraoperative hemorrhage. The accompanying arteries and veins in the NVB, which are visible with Doppler ultrasound, can serve as a macroscopic landmark to localize the microscopic cavernous nerves in the NVB. A new solution for guiding the surgeon in RALP is image-guided navigation using transrectal ultrasound (TRUS). A TRUS-guided intraoperative navigation system using a robotic ultrasound probe manipulator (TRUS Robot) has been developed. The proposed research is a pilot clinical trial of the TRUS Robot and three- dimensional (3-D) navigation software to test its image-guidance ability of helping the surgeon during RALP. This is a dual robot approach, a Tandem-RALP (T-RALP). The TRUS Robot allows a steady holding as well as remote manipulation of the TRUS probe. In addition, the TRUS Robot can track the accurate position of TRUS probe which allows 3-D reconstruction of the images. The use of TRUS imaging during radical prostatectomy can potentially improve the visualization of the NVB and subsequently improve postoperative recovery of potency in men. In addition, the 3-D reconstruction images of the prostate gland can provide clear and accurate guidance of surgical landmarks to the surgeon. In this quick trial, the efficacy and safety of the T-RALP approach of using both the TRUS Robot and 3-D navigation software will be evaluated by 1) assessing the distance between the expected versus true locations of neurovascular bundles (NVB), 2) measuring the distance between prostatic landmarks, and 3) quantifying the incidence of associated complications including rectal injury. The eventual goal of the T-RALP approach is to improve the surgical resection for prostate cancer while better preserving the NVB and reducing side effects. PUBLIC HEALTH RELEVANCE: Robot-assisted laparoscopic radical prostatectomy (RALP) is a commonly performed surgery for prostate cancer, the most common non-skin cancer in US men. We propose to use a novel, robotic transrectal ultrasound probe manipulator (TRUS Robot) and three-dimensional (3-D) reconstruction/navigation software to enable the intraoperative use of TRUS during RALP for image-guided navigation. If proven safe and effective in this quick trial, the use of TRUS-based navigation during RALP can be helpful for a precise resection of the tumor- containing prostate gland, the improved preservation of the neurovascular bundle and the decrease in associated postoperative side effects.